ABSTRACT
Osteoradionecrosis (ORN) is a painful and debilitating serious late complication following treatment for head and neck cancer (HNC) often requiring surgical resection of the jaw and complex multidisciplinary management. An important aggravating factor for mandibular ORN is surgical trauma, commonly dental extractions or implant placement following head and neck radiotherapy. The evidence on the treatment protocols ranges from conservative management to more radical surgical strategies including the use of hyperbaric oxygen therapy. The available evidence on the preventive approaches for ORN includes prophylactic dental care prior to radiotherapy, the use of hyperbaric oxygen (HBO) treatment and prophylactic antibiotics for post-radiotherapy extractions. However, the efficacy of hyperbaric oxygen therapy has been questioned recently signifying poor understanding of the pathophysiology of the condition and therapies targeting the fibroatrophic process have become a focus of ORN treatment. Implementing recent IMRT radiation techniques has also shown evidence to reduce the incidence of ORN. This review provides an insight into the variations in definition and classification of the ORN, the controversies in its pathophysiology and the advances in the prevention and management.
ABSTRACT
BACKGROUND: In orthopaedic surgery where metallic implants are used, surgical site infection (SSI) is a significant complication as it increases the postoperative morbidity and mortality, prolongs hospital stay, and increases the hospital costs. Therefore, understanding the incidence of SSI in various healthcare settings would help us analyse the contributing factors and improve healthcare. Since the rates of SSI in various orthopaedic settings in India are lacking, this study aimed at analysing them and various associated factors in a tertiary medical institute in India. MATERIALS AND METHODS: This study was a prospective cohort study carried out on 100 orthopaedic patients who underwent surgical fixation for closed fractures, with a follow-up period of one year. The incidence of SSI and the factors associated with them were analysed. RESULTS: The overall incidence of SSI in our study was 5% (5 cases). The maximum incidence was seen in the age group 51-60 years (40% of the infections). Regarding the duration of preoperative hospital stay, the incidence of SSI was 6.85% when the patients stayed for more than 10 days, whereas the incidence was only 1.66% when the patients stayed for less than or equal to 10 days. Among the diabetics, the incidence of infection was found to be 7.69% (1 out of 13 diabetics). Regarding the operative duration, while cases which took more than 1.5 hours of operative duration had the highest infection rate (60% of the infections), none of the cases which took less than an hour to operate got infected. Among the infective organisms isolated, 60% cases had Staphylococcus aureus, 20% had Proteus vulgaris and another 20% had Klebsiella pneumoniae infection. CONCLUSIONS: Age greater than 50 years, a prolonged preoperative hospital stay more than 10 days, presence of diabetes, a prolonged surgical procedure more than 1.5 hours, and were found to be at a higher risk of SSI in our study.
ABSTRACT
BACKGROUND: Heat generation during osteotomy site preparation is a crucial factor that determines the success of dental implant placement. Among the factors that affect the heat generation, drilling speed, hand pressure and coolant temperature are independent variables. However, a relation between these three parameters and their optimal values required for the maximum outcome has not been studied so far. This study aims at finding out a relation between these factors in order to derive the optimum balance required, using an in vitro study. MATERIAL AND METHODS: This in vitro experiment was performed on bovine femur. A total of 72 drillings were undertaken with the aid of a physiodispenser mounted on the test apparatus. Drill diameters of 2 mm and 2.8 mm, rotated at 1500, 2000 and 2500 rpm were included for the analysis. Hand pressures included for the comparison were 1.2 kgf and 2.4 kgf. Normal saline at room temperature, and that chilled to 00C were used for external irrigation. The temperature generated during drilling was recorded by infrared thermography using a Forward-Looking Infrared (FLIR) camera. RESULTS: The highest temperature during osteotomy was observed at 2000 rpm rotational speed, 1.2 kgf operator hand pressure and saline irrigant solution at room temperature. In contrast, the lowest temperature generated was using 2500 rpm rotational speed, 2.4 kgf operator hand pressure and chilled irrigant solution. CONCLUSIONS: The results indicate that none of the three experimented parameters generated heat above the critical temperature for bone necrosis (47°C). Thus, a high drilling speed with high hand pressure and continuous irrigation with copious amounts of cooled saline may be the ideal combination for implant osteotomy site preparation. Key words:Heat generation, dental implant drills, drilling speed, drilling pressure, irrigation, infrared thermography, thermal necrosis, osteotomy preparation.
ABSTRACT
Trismus refers to a person's inability to normally open his or her mouth. Trismus can occur as a symptom due to tumor ingrowth or it can occur postsurgical following the treatment for head and neck cancer. Radiation-induced trismus is also a relatively common oral complication. This review aimed at reviewing the etiopathogenesis of trismus in patients with head and neck cancer. Of the 16 publications included after final screening, of which one was a nonrandomized control trial, one a randomized control trial, 6 prospective cohort studies, and 8 retrospective cohort studies. Among them, 6 articles addressed the possible mechanism for trismus related to tumor ingrowth, 8 articles suggested the likely reason for trismus in patients who had undergone radiation therapy and 2 articles addressed the postsurgical cause for trismus. This review highlights the possible involvement of infratemporal fossa as a predetermining factor for developing trismus related to tumor extension. The molecular mechanism of radiation-induced fibrosis is well studied in the literature.
